Eccher Albino, Carraro Amedeo, Girolami Ilaria, Villanova Manuela, Borin Alex, Violi Paola, Paro Barbara, Mescoli Claudia, Malvi Deborah, Novelli Luca, D'Errico Antonietta, Rossini Giuseppe, Ungari Marco
Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy.
General Surgery and Liver Transplant Unit, University and Hospital Trust of Verona, Verona, Italy.
Am J Case Rep. 2021 Feb 13;22:e929348. doi: 10.12659/AJCR.929348.
BACKGROUND Guidelines have been designed to stratify the risk of cancer transmission in donors with a history of or ongoing malignancy, although this evaluation is not always straightforward when unexpected and rare lesions are found. CASE REPORT Here, we present a case of a 41-year-old African female donor who died from a cerebral hemorrhage. Her medical history was unavailable. At procurement, multiple diffuse grayish small nodules were noticed along the peritoneal cavity, some of which were sent to the on-call pathologist for urgent frozen section evaluation. Histology showed a multinodular proliferation of uniform bland-appearing spindle cells, with no evidence of necrosis, nor nuclear atypia or mitoses. The overall picture was consistent with the diagnosis of disseminated peritoneal leiomyomatosis, with overlapping morphology with uterine leiomyoma. Given the rarity of the lesion and the potential for recurrence or malignant degeneration, only the liver and heart were allocated to recipients with life-threatening conditions. The decision was taken in a forcedly limited time and took into account the benefit of transplantation and the risk of disease transmission. CONCLUSIONS This case highlights challenges that transplant teams often have to deal with, as lesions that are difficult to diagnose during donor assessment are usually not covered in guidelines. The acceptance and usage of organs in such cases has to be decided in a team-based fashion, with the collaboration of all the transplant professionals involved to optimally assess the transmission risk, carefully balancing the benefits of transplantation for the recipients and the need to guarantee a reasonable degree of safety.
背景 已制定指南对有恶性肿瘤病史或正在患恶性肿瘤的供体的癌症传播风险进行分层，尽管当发现意外和罕见病变时，这种评估并不总是那么简单直接。病例报告 在此，我们报告一例41岁非洲女性供体，其死于脑出血。其病史不详。在获取器官时，沿腹腔发现多个弥漫性灰白色小结节，其中一些被送去给随叫随到的病理学家进行紧急冰冻切片评估。组织学显示均匀一致、外观温和的梭形细胞呈多结节性增生，无坏死、核异型性或有丝分裂的证据。总体表现符合播散性腹膜平滑肌瘤病的诊断，形态学与子宫平滑肌瘤重叠。鉴于该病变罕见且有复发或恶性变的可能，仅将肝脏和心脏分配给有生命危险的受者。这一决定是在时间紧迫的情况下做出的，同时考虑了移植的益处和疾病传播的风险。结论 本病例突出了移植团队经常不得不应对的挑战，因为供体评估期间难以诊断的病变通常不在指南范围内。在这种情况下，器官的接受和使用必须以团队方式决定，所有参与的移植专业人员共同协作，以最佳方式评估传播风险，仔细权衡对受者移植的益处以及保证合理安全程度的必要性。
